Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0137551 | NM |
N | 101YP1600X | Pastoral Counselor | 14967 | FL |
NPI | 1104159060 |
---|---|
Provider Name | Ms. Chandra S. Gordon |
First Address | Milan, NM 87021-3348 |
Second Address | Grants, NM 87020-2103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2009 |
Last Update Date | 21/03/2013 |